North America's First Heroin Prescription
Program
Introduced in Canadaby Am Johal
www.dissidentvoice.org
March 19, 2005

Vancouver,
Canada
-- In February, Vancouver became the first city in North America to begin
clinical trials for heroin prescription. This step, which required an
exemption of Section 56 of the Controlled Drug and Substances Act, came a
year and a half after Vancouver had opened North America's first safe
injection site.

Dr. David Marsh, a UBC
Clinical Associate Professor in the Department of Healthcare and
Epidemiology says, “Each research subject will be on either heroin or
another approved treatment substitute such as methadone.” According to him,
Switzerland and Netherlands have already approved regular treatment with
heroin maintenance as part of the continuum of care after over 20,000
patient years of research. Marsh himself has worked for eight years in
Canada to have the North American Opiate Medication Initiative (NAOMI) study
approved.

Some addicts in the
community have criticized parts of the study in the locally based Vancouver
Sun, which require participants to give urine samples, reveal their
medical history and a criminal record if they have one. They feel that there
are too many barriers to enter the program and that it does not include
enough participants.

The site location is
in Vancouver's
downtown eastside neighborhood, in the downtown peninsula, not far from
where the Olympic Games will take place in 2010. It is located near the
existing health board managed safe injection site where users bring in their
own drugs from the street. The purity of heroin available on the street has
been an issue in the past and was deemed to be a contributing factor in many
overdose deaths.

The intake of
participants for the study will happen over the next year and each
participant will be part of the study for one year. Due to the staggered
time frame of entry, the study will take over two years to complete and will
include Montreal in May and Toronto a few months later.

Initially, the study
will take addicts with a documented case history of 5 years of heroin
dependence, daily use for a year, 25 years of age and older, have tried
methadone more than once, and people who live within a mile of the study
site. This project is funded through the Canadian Institute of Health
Research Studies and supported by the BC Ministry of Health and Health
Canada.

Jim Boothroyd,
Communications Director for the BC Centre for Excellence in HIV/AIDS, says,
“Much of the criticism is limited to addiction specialists who question the
ethics of the study. This study, however, has been reviewed by the Ethical
Review Boards at the University of British Columbia, McGill in Montreal and
the Center for Addiction and Mental Health which is affiliated with the
University of Toronto.”

There has been
criticism of the expansion of health services in the downtown eastside
neighborhood by business groups and some resident associations who feel that
the expansion has only exacerbated the problems. Provincial cuts including
placing limits on the length of time an individual can collect social
assistance has increased homelessness in the neighborhood where drugs are
readily available.

Since 1990, over 2,000
overdose deaths happened in British Columbia, and by 1997 Health Canada had
declared a public health emergency in the Downtown Eastside neighborhood
where HIV/AID rates were reaching 25% of drug users and TB and Hepatitis C
rates were abnormally high. This led to numerous planning and zoning turf
wars that pitted competing neighborhood interests against one another.

The former coroner,
who had dealt with many of the overdose deaths, was elected mayor in 2002.
Mayor Larry Campbell says, “For those who can't stop taking drugs, this is
an attempt to stabilize their life. This program is designed to get to the
most chronic users.”

Dean Wilson, the
former head of a health board funded drug user group and the subject of a
documentary on
Vancouver's
drug issues praises the project. “If we truly believe that addiction is a
medical condition, then we need to treat it as such -- we need to treat this
as a medical issue, not a criminal issue.”

Wilson
says the research project is the appropriate action and should not have
taken so long to get started. He says he knows the first person who joined
the study and he's already noticed the difference in the person he's known
for over 25 years. “He doesn't have to run around all day figuring out how
he's going to get his next fix -- you can see the difference it makes to his
self-esteem. I can notice the difference in him after one day.”

Dr. Dan Small of the
PHS Community Services Society says that the researchers behind the study
should be lauded for their courageous attempts to see the study through.
Small says, “This is more than establishing a standard of care, it's about
establishing a standard of caring. Illness does not just exist in a clinic
or as a subject of study for researchers, but is an on-the-ground life and
death reality for people. The barriers which exist as part of the study
are, nonetheless, barriers. For the participants of this study who are
suffering this is not a pilot project, this could be a life saving
intervention.”

If the study shows
that heroin maintenance does work in treating addiction, Small questions if
the relevant agencies will be ready to move forward at the legislative level
to make the changes that are necessary.

“We all make bad
choices in life, and if the choice is made and someone becomes addicted,
then we still have a responsibility to treat addiction as a health issue --
it's a common sense thing,” says Kim Kerr, Executive Director of the
Downtown Eastside Residents Association. “It is a step in the right
direction. Methadone around here is a license to print money for the
doctors and pharmacies. It's even being sold on the street.”